Abstract
Complex tibial plateau fractures in elderly patients exhibiting severe osteoporosis and articular surface collapse are challenging. Decision-making is difficult when the posterior column is involved. Open reduction and internal fixation of complex tibial plateau fractures in patients with severe osteoporosis are prone to failure. In this paper, we describe a new method for the maintenance of the articular surface of complex tibial plateau fractures in elderly patients. An anterior horizontal rafting plate (3.5-mm-thick reconstruction and locking plate [Zimmer Inc., Warsaw, IN, USA]) is placed via conventional posteromedial and anterolateral incisions. The plate is inserted between the anterior bony surface of the proximal tibia and the subpatellar fat pad; plate positioning is checked under direct vision. The patient is encouraged to begin functional recovery soon after operation. Progressive weight-bearing begins at 10 weeks postoperatively and is gradually increased during fracture healing. Clinical follow-up was performed at 4, 8, and 12 weeks, 6 and 12 months, and yearly thereafter. No articular collapse or fragment displacement was evident on three-dimensional computed tomography performed 6 months after surgery. The knee range of motion was 5-130º at the last follow-up (4 years after surgery). This technique may be a good option for treating complex tibial plateau fractures, especially in elderly patients with severe osteoporosis.